Are you suffering from Spinal Stenosis? Having lower back pain with leg pain and numbness? You are at the right place. Get professional opinion and treatment on your Spinal Stenosis. Call us for appointment today. Tel: +65 64712744 or SMS to: +65 92357641 (24 Hours Hotline).

There are two types of spinal stenosis: lumbar stenosis and cervical stenosis. While lumbar spinal stenosis is more common, cervical spinal stenosis is often more dangerous because it involves compression of the spinal cord, as explained below in more detail.

Lumbar Spinal Stenosis VS Cervical Spinal Stenosis

In lumbar stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of sciatica — tingling, weakness or numbness that radiates from the low back and into the buttocks and legs – especially with activity.

Spinal stenosis pain in the neck (cervical spinal stenosis) can be far more dangerous by compressing the spinal cord. Spinal cord stenosis may lead to serious symptoms, including major body weakness or even paralysis. Such severe spinal stenosis symptoms are virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine.

In rare cases, lumbar stenosis can go no further than to produce severe persistent disabling pain and even weakness in the legs. Most cases of stenosis in the lumbar spine, however, have pain that radiates into the leg(s) with walking, and that pain will be relieved with sitting.

Spinal Stenosis in Older Patients

Spinal stenosis is related to degeneration in the spine and usually will become significant in the 5th decade of life and extend throughout every subsequent age group. Most patients first visit their doctor with symptoms of spinal stenosis at about age 60 or so. Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with significant activity limitations, such as leg pain and/or difficulty with walking.

Spinal stenosis can occur in a variety of ways in the spine. Approximately 75% of cases of spinal stenosis occur in the lumbar spine (low back), which is called lumbar spinal stenosis, and most will affect the sciatic nerve which runs along the back of the leg. When this happens, it is commonly called sciatica.

Common Symptom of Spinal Stenosis

Leg pain with walking (claudication) can be caused by either arterial circulatory insufficiency (vascular claudication) or from spinal stenosis (neurogenic or pseudo-claudication). Leg pain from either condition will go away with rest, but with spinal stenosis the patient usually has to sit down for a few minutes to ease the leg and often low back pain, whereas leg pain from vascular claudication will go away if the patient simply stops walking.

Although occasionally the leg pain and stenosis symptoms will come on acutely, they generally develop over the course of several years. The longer a patient with spinal stenosis stands or walks, the worse the leg pain will get.

Common Treatment of Spinal Stenosis

Depending on the severity of symptoms, spinal stenosis can often be managed through non-surgical treatments.

The three most common non-surgical spinal stenosis treatments include:

Exercise

Activity modification

Epidural injections

Fortunately, spinal stenosis surgery outcomes for decompression can be among the most rewarding surgical methods used on the spine (second only to removal of some herniated discs). Generally patients do well after decompression surgery and are able to increase their activity following recovery from spinal stenosis surgery. Many patients have a better walking tolerance following back surgery for spinal stenosis.

Are you suffering from Spinal Stenosis? Having lower back pain with leg pain and numbness? You are at the right place. Get professional opinion and treatment on your Spinal Stenosis. Call us for appointment today. Tel: +65 64712744 or SMS to: +65 92357641 (24 Hours Hotline).

Guide to Low Back Pain

What Is Low Back Pain?

Low back pain is a universal human experience — almost everyone has it at some point. The lower back, which starts below the ribcage, is called the lumbar region. Pain here can be intense and is one of the top causes of missed work. Fortunately, low back pain often gets better on its own. When it doesn’t, there are effective treatments.

Symptoms of Low Back Pain

Symptoms range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Acute back pain comes on suddenly, often after an injury from sports or heavy lifting. Pain that lasts more than three months is considered chronic. If your pain is not better within 72 hours, you should consult a doctor.

Symptoms That Require Urgent Care

Severe back pain after a fall or injury should be checked out by a health care professional. Other warning signs include a loss of bowel or bladder control, leg weakness, fever, and pain when coughing or urinating. If you have any of these symptoms along with your back pain, contact your doctor.

Muscle Strain or Sciatica?

The kind of back pain that follows heavy lifting or exercising too hard is often caused by muscle strain. But sometimes back pain can be related to a disc that bulges or ruptures. If a bulging or ruptured disc presses on the sciatic nerve, pain may run from the buttock down one leg. This is called sciatica.

Back Pain Culprit: Your Job

If your job involves lifting, pulling, or anything that twists the spine, it may contribute to back pain. However, sitting at a desk all day comes with risks of its own, especially if your chair is uncomfortable or you tend to slouch.

Back Pain Culprit: Your Bag

Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body — including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase.

Back Pain Culprit: Your Workout

Overdoing it at the gym or golf course is one of the most common causes of overextended muscles leading to low back pain. You’re especially vulnerable if you tend to be inactive during the work week and then spend hours at the gym or softball field on the weekend.

Back Pain Culprit: Your Posture

Mom was right when she said, “Stand up straight!” Your back supports weight best when you don’t slouch. This means sitting with good lumbar support for your lower back, shoulders back, with feet resting on a low stool. When standing, keep weight evenly balanced on both feet.

Back Pain Culprit: Herniated Disc

The spine’s vertebrae are cushioned by gel-like discs that are prone to wear and tear from aging or injuries. A weakened disc may rupture or bulge, putting pressure on the spinal nerve roots. This is known as a herniated disc and can cause intense pain.

Back Pain Culprit: Chronic Conditions

Several chronic conditions can lead to low back pain.

Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.

Spondylitis refers to chronic back pain and stiffness due to severe inflammation of the spinal joints.

Fibromyalgia causes widespread muscle aches, including back pain.

Who’s at Risk for Low Back Pain?

Most people get their first taste of low back pain in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include:

Being overweight

Inactive lifestyle

Jobs that require heavy lifting

Diagnosing Low Back Pain

To help your doctor diagnose the source of low back pain, be specific in describing the type of pain, when it started, related symptoms, and any history of chronic conditions. Your doctor may order X-rays, CT or MRI scans to look for damaged bones or discs, or other injuries to the spine.

Home Care for Low Back Pain

Back pain due to muscle strain will usually get better on its own, but you can take steps to make yourself more comfortable. A heating pad or warm baths may provide temporary pain relief.

The Bed Rest Debate

When your back hurts, you may not feel like getting out of bed. But if the problem is muscle strain, doctors recommend returning to your normal activities as soon as possible. Studies suggest that any more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility.

Yoga

If back pain doesn’t go away in three months, there’s evidence that yoga can help. In one recent study, people who took 12 weeks of yoga classes had fewer symptoms of low back pain than people who were given a book about care for back pain. The benefits lasted several months after the classes were finished. The study suggests conventional stretching also works just as well. Make sure your instructor is experienced at teaching people with back pain and will modify postures for you as needed.

Medications

Mild back pain often feels better with over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen. Pain-relieving creams may be helpful for muscle aches. For severe pain or chronic pain, your doctor may recommend prescription medication.

Injections

If simpler therapies and medications aren’t helping, your doctor may recommend injections to the back. One procedure, called a nerve root block, targets irritated nerves. Injections for back pain usually contain steroid medication.

Surgery

If long-lasting back pain is interfering with your daily life, and other treatments have not provided relief, you may be a candidate for surgery. Depending on the cause of your pain, a surgeon may remove a herniated disc, widen the space around the spinal cord, and/or fuse two spinal vertebrae together.

Physical Therapy

If back pain has left you inactive for a long time, a rehabilitation program can help you strengthen your muscles and get back to your daily activities. A physical therapist can guide you through stretches, strength exercises, and low-impact cardio that will help you be fitter without straining your back.

Strengthening the Back

Two types of strength-training moves that may benefit the lower back are flexion and extension exercises. In flexion exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.

Preventing Low Back Pain

There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:

Stay at a healthy weight.

Exercise regularly.

Lift with your legs, not your back.

Make sure your work station position isn’t contributing to your pain.

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Prevent Back Pain with Good Posture

When it comes to posture, your mother did know best. Her reminders to stand up straight and stop slouching were good advice.

Your spine is strong and stable when you practice healthy posture. But when you stoop or slouch, your muscles and ligaments struggle to keep you balanced — which can lead to back pain, headaches and other problems.

A healthy back has three natural curves:

An inward or forward curve at the neck (cervical curve)

An outward or backward curve at the upper back (thoracic curve)

An inward curve at the lower back (lumbar curve)

Good posture helps maintain these natural curves, while poor posture does the opposite — which can stress or pull muscles and cause pain.

When standing, keep these tips in mind:

Keep your shoulders back and relaxed.

Pull in your abdomen.

Keep your feet about hip distance apart.

Balance your weight evenly on both feet.

Let your hands hang naturally at your sides.

Try not to tilt your head forward, backward or sideways, and make sure your knees are relaxed — not locked.

To test your standing posture, take the wall test. Stand with your head, shoulder blades and buttocks touching a wall, and have your heels about 2 to 4 inches (about 5 to 10 centimeters) away from the wall. Reach back and slide your hand behind the curve in your lower back, with your palm flat against the wall.

Ideally, you’ll feel about one hand’s thickness of space between your back and the wall. If there’s too much space, tighten your abdominal muscles to flatten the curve in your back. If there’s too little space, arch your back so that your hand fits comfortably behind you. Walk away from the wall while maintaining this posture. Keep it up throughout your daily activities.

When seated, keep these tips in mind:

Choose a chair that allows you to rest both feet flat on the floor while keeping your knees level with your hips. If necessary, prop up your feet with a footstool or other support.

Sit back in your chair. If the chair doesn’t support your lower back’s curve, place a rolled towel or small pillow behind your lower back.

Stretch the top of your head toward the ceiling, and tuck your chin in slightly.

To see if you’re keeping your shoulders straight, stand in front of a mirror or ask someone else to evaluate your shoulder position. Aim to keep your shoulders in the same position as shown in the image on the left.

Although good posture should be natural, you might feel wooden or stiff at first if you’ve forgotten the sensation of sitting and standing up straight. The key is to practice good posture all the time. You can make improvements at any age. Stretching and core strengthening exercises can help, too.

Lower back pain can be acute or severely painful or can be a long term moderate pain from a chronic back injury.

We explain the differences between acute low back pain and moderate chronic low back and its management.

Often is not possible to completely diagnose the causes of low back pain. Below we also outline the most common diagnosable causes of low back pain, less common causes and other conditions which can cause low back pain.

Acute VS Chronic Low Back Pain

Acute low back pain is severe back pain and usually comes on suddenly caused by a movement such as bending or twisting. Pain in the lower back and buttocks may increase over a couple of hours as inflammation develops. Management of acute low back pain is to reduce pain as quickly as possible by getting the patient into a position of least pain which may be lying on the back, front or side. Whatever is most comfortable is the best and it will be different for each individual. See management of acute low back pain for more detailed information.

Mild or moderate lower back pain is associated with chronic or long term back problems which are usually caused initially by an injury, usually to the joints in the back but over time other structures in particular soft tissue such as muscles contribute to the pain. A range of symptoms include dull aching in the lower back which may come and go, be on one side or across the lower back. There will be reduced range of movement, tenderness at points on the spine, muscle spasms and pain may radiate into the buttocks and hamstrings.

Common Causes of Low Back Pain

Often the exact cause of low back pain is not possible to identify. Symptoms can be vague, come and go and there can be a number of tissues and structures causing the pain. However below are some injuries and conditions that can usually be diagnosed.

Sciatica or nerve route compression causes pain in the lower back which radiates down into the legs. There are a number of causes by a slipped disc is one of the more common causes.

Facet joint pain or zygapophysial joints as they are also know are synovial joints in the spine which allow movement and help support the spine. Symptoms of facet joint pain include muscle spasm at the side of the spine which pulls the vertibra out of line. Patients will often report a sudden pain when bending over or moving.

Spondylolysis or stress fracture of the pars interarticularis is an overuse injury more common in younger athletes who are involved in sports requiring a lot of bending backwards and rotation of the spine such as javelin throwing, tennis, baseball pitching and fast bowling in cricket. Symptoms include lower back pain often on one side of the back. Pain is worse during activities requiring backwards bending of the spine or exaggerating the lumbar curve in the spine. Tenderness will be felt over the site of the fracture when pressing in.

Sacroiliac joint pain occurs when the joint between the sacrum at the bottom of the spine and the ilium bone of the pelvis is not functioning correctly. It can be locked and not moving freely or it may be that there is too much movement in the joint. Symptoms of sacroiliac joint pain include pain located at either the left or right side of the lower back, not not usually both sides. The pain can vary from a dull ache to a sharp stabbing pain which can radiate into the buttocks. Occasionally sacroiliac joint dysfunction can cause pain in the testicles. Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning is also common.

Muscular trigger points are tiny localized knots in the muscle which cause pain either at the location of the trigger point or referred elsewhere in the back. They are common in the errector spinae muscles which go up either side of the spine and the deep quadratus lumborum muscles either side of the lumbar spine. Deep tissue sports massage techniques are effective for releasing trigger points in the muscles and relieving muscular back pain.

Less Common Causes of Low Back Pain

Spondylolisthesis is most common in children aged between 9 and 14 years old and involves a slipping forward of one of the lumbar vertebra. Spondylolisthesis can vary in severity from a grade one where there may be no symptoms or pain at all and patients are unaware they have the condition to a grade two which may result in low back pain made worse by activity but not radiating into the legs. A grade three injury has greater than 50% forward movement of the vertebra and a grade 4 will be very debilitating with more than 75% movement in the bone.

Spinal canal stenosis is more common in older athletes and involves the spinal canal narrowing causing pressure on the nerves with symptoms of pain and numbness. Sciatic type symptoms may also be present along with weakness of the legs. An X-ray of the spine can confirm the diagnosis.

Fractured vertebra or compression fracture of the spine is a break or fracture of one of the vertebra bones and is usually due to compressive forces. Occurring most frequently in the lower back symptoms include pain at the site of the fracture which may radiate in the hips, buttocks or thighs. Numbness, tingling and weakness may also be experienced and bladder or bowel symptoms from the fracture pressing onto the spinal cord can occur.

Fibromyalgia is a widespread muscular fatigue and pain condition where pain and tenderness is felt throughout the body. Poor sleep patterns are common and the muscles may feel soft and doughy rather than toned and tight. Patients often complain that they ache all over or feel they have overworked the muscles. Irritable bowel syndrome, Dysmenorrhea (cramps or painful menstruation) and chronic headaches are also symptoms of fibromylagia.

Lumbar instability is where part of the spine is unstable or has too much movement. Most low back problems can be relieved by freeing up a hypomobile vertebra or one that has restricted movement, although mobilizing and already mobile joint is not going to be beneficial. In this case the surrounding structures and muscles should be strengthened to support the unstable back. Core strengthening exercises and Pilates exercises for the back are likely to be beneficial. It is possible to have a generally hypomobile spine but with one or two vertebra having restricted mobility. It is important to get an accurate diagnosis and treatment from a back specialist, Osteopath or Chiropractor as the wrong treatment or exercises can have a negative effect.

Other medical conditions and diseases that can have symptoms of lower back pain include rheumatological diseases, gynacologica, gastrointestinal as well as genitourinary problems. If in doubt seek advice from a doctor.

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Back pain is extremely common – about four in five people are affected at some point in their lifetime. Anyone can get back pain at any age, but it’s most common in people between the ages of 35 and 55, or over.

Your back has many interconnecting structures, including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.

It’s often very difficult to know exactly what causes back pain, but it’s usually thought to be related to a strain in one of the interconnecting structures in your back, rather than a nerve problem. Back pain caused by a more serious, underlying condition is rare and you’re unlikely to be affected unless you are very old or very young.

Symptoms of Low Back Pain

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain and usually improves on its own within a few days.

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

acute back pain – lasting less than six weeks

sub-acute back pain – lasting six weeks to three months

chronic back pain – lasting longer than three months

You should see a doctor as soon as possible if, as well as back pain, you have:

a fever (high temperature)

redness or swelling on your back

pain down your legs and below your knees

numbness or weakness in one or both legs or around your buttocks

loss of bladder or bowel control (incontinence)

constant pain, particularly at night

pain that is getting much worse and is spreading up your spine

These symptoms are known as red flags. It’s important to seek medical help for these symptoms to ensure you don’t have a more serious, underlying cause for your back pain.

For most people with back pain, there isn’t any specific, underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:

standing, sitting or bending down for long periods

lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way

having a trip or a fall

being stressed or anxious

being overweight

having poor posture

There may be other, more serious underlying causes of your low back pain, but these are rare. They include:

fracture – a crack or break in one of the bones in your back

osteoporosis – a condition where bones lose density causing them to become weak, brittle and more likely to break

a slipped disc – this is when a disc bulges so far out that it puts pressure on your spinal nerves

spinal stenosis – a condition in which the spaces in your spine narrow

spondylolithesis – when one of your back bones slips forward and out of position

degenerative disc disease – when the discs in your spinal cord gradually become worn down

osteoarthritis – a wear-and-tear disease that can particularly affect the joints of your spine

rheumatoid arthritis – an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures

Low back pain may also be caused by an infection or cancer, but these two causes are very rare.

Diagnosis of back pain

A doctor will usually be able to diagnose low back pain from your symptoms and there will be no need for further tests. If, however, your symptoms don’t improve after a few weeks, or you have some red flag symptoms, he or she may refer you to have:

an X-ray

a CT scan (a test that uses X-ray equipment and computer software to create pictures of the inside of your body)

an MRI scan (a test that uses magnets and radiowaves to produce images of the inside of the body)

blood tests

These tests are used to find out if you have a more specific, underlying cause for your back pain.

Please note that availability and use of specific tests may vary from country to country.

Treatment of back pain

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.

Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin (acetylsalicylic acid) or paracetamol (acetaminophen), or anti-inflammatory medicine such as ibuprofen is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain. Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy. Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

take regular exercise – walking and swimming are particularly beneficial

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body’s weight.

Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better.

Low back pain may be acute (short-term), lasting less than one month, or chronic (long-term, continuous, ongoing), lasting longer than three months. While getting acute back pain more than once is common, continuous long-term pain is not.

Causes of Back Pain:

You’ll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But prior to that moment in time, the structures in your back may be losing strength or integrity.

The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain:

Aortic aneurysm

Degeneration of the disks

Kidney problems, such as infections or stones

Muscle spasm (very tense muscles that remain contracted)

Other medical conditions like fibromyalgia

Poor alignment of the vertebrae

Ruptured or herniated disk

Small fractures to the spine from osteoporosis

Spinal stenosis(narrowing of the spinal canal)

Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens

Strain or tears to the muscles or ligaments supporting the back

Low back pain from any cause usually involves spasms of the large, supportive muscles alongside the spine. The muscle spasm and stiffness accompanying back pain can feel particularly uncomfortable.

You are at particular risk for low back pain if you:

Are over age 30

Are pregnant

Feel stressed or depressed

Have a low pain threshold

Have arthritis or osteoporosis

Have bad posture

Smoke, don’t exercise, or are overweight

Work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster)

Prevention of Lower Back Pain

Exercise is important for preventing future back pain. Through exercise you can:

Improve your posture

Strengthen your back and improve flexibility

Lose weight

Avoid falls

A complete exercise program should include aerobic activity (like walking, swimming, or riding a stationary bicycle) as well as stretching and strength training.

To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:

If an object is too heavy or awkward, get help.

Spread your feet apart to give a wide base of support.

Stand as close to the object you are lifting as possible.

Bend at your knees, not at your waist.

Tighten your stomach muscles as you lift the object up or lower it down.

Hold the object as close to your body as you can.

Lift using your leg muscles.

As you stand up with the object, DO NOT bend forward.

DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to take to prevent back pain include:

Avoid standing for long periods of time. If you must for your work, try using a stool. Alternate resting each foot on it.

DO NOT wear high heels. Use cushioned soles when walking.

When sitting for work, especially if using a computer, make sure that your chair has a straight back with adjustable seat and back, armrests, and a swivel seat.

Use a stool under your feet while sitting so that your knees are higher than your hips.

Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.

If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don’t lift heavy objects just after a ride.

Most people suffer from mild back pain from time to time and the exact cause of which may be difficult to diagnose. It is usually a sign that one or more muscles, joints, ligaments or discs are over-stretched or twisted by movement of the back in an awkward position. Severe pain may be the result of pressure on nerves from the misalignment of the bones in the back and warrants immediate medical attention.

Low back pain afflicts some 80 % of the adult population some time or other in their lives.

Many episodes of pain last only several hours or a day or two. By and large, 90% of patients should have recovered from their initial attack of pain by 6 weeks from the onset.

Symptoms

Early medical attention is necessary if certain symptoms (“red flags”) are present:

Constant pain with no significant relief at rest

Aggravated by bending in all directions

Localisable severe pain to a single spot on the back

Progressively severe pain over days/weeks

Persistent nerve pains, pain or sensation of numbness, pins & needles aching in one or both legs

Treatment

Rest is very crucial for patients with episodic attacks of back pain. Rest here may involve going home and lying down for a few hours, or it may be as simple as keeping the back straight and avoiding further stress to the back in the form of bending, lifting and sitting. In severe attacks, lying down for a day or two may significantly reduce the severity of the pain. If it does not, further bed -rest is not helpful.

Physical therapy is very important in the treatment and prevention of low back pain. In the initial period of acute back pain, combinations of heat, traction, manual treatment, and other techniques may help to rapidly reduce the severity of pain and stiffness. As pain subsides, exercises, to relieve stress and strengthen the back ,are gradually introduced. Regularity of such exercises can help to further reduce the pain, as well as protect the back from unhealthy stress and recurrent attacks of pain.

Different types of medications may be prescribed for different types of back pain.

In acute sciatica or leg pain associated with back disorders, the acute irritation of the nerve may be reduced by taking NSAIDS regularly for a short period of time. NSAIDS are often prescribed purely for pain relief rather than for anti-inflammatory effects. It is based on an as-required basis. These drugs are to be avoided if there is a history of allergy and kidney problems. In most cases, NSAIDS are well-tolerated, though most of them provoke gastric symptoms. The doctor must always be consulted.

Muscle relaxants help to reduce muscle spasm and stiffness that occurs during a pain attack. Sedatives and tranquilisers may be taken at night to ensure a restful sleep.

Ice packs, hot packs or heating lamps, ointments that usually contain methyl -salicylate and medicated plasters of various kinds may help.

30 – 40 % of patients suffer a relapse during the first few months following the attack. It is important to identify the factors that aggravated the pain.

I have severe back pain and sciatica that has not improved even with treatment. What should I do?

X-rays of the low-back should be obtained. Conditions like spondylolisthesis, infection and tumour should be excluded. Sophisticated imaging techniques such as MRI ( magnetic resonance imaging) may be required . MRI scans can show the severity of a prolapsed disc and more importantly , the degree of the nerve compression, if any. Other investigations such as bone scan, CT scans or myelograms may be performed in certain conditions.

Prevention

Try to modify the activity so that it is less likely to strain the back

Interrupt a repetitive task frequently by standing and stretching. This helps to reduce the stress on the back from building up to critical levels

Exercise programmes must be balanced to exercise all parts of the body, including the back.

Exercises should be done frequently in measured doses.

Slipped Disc

As a person gets older, a process called degeneration, the nucleus in the lower few discs of the low back . As a result , the discs are less capable of cushioning the spine , especially during repeated stressful activities. The capsule or annulus can then tear and cause pain. This is known as a slipped disc.

In a slipped disc, the annulus tears with different degrees of severity. Small tears heal quickly. Large tears can cause a small portion of the nucleus herniating through the tear to lie outside the wall of the disc. If this herniation is close to a nerve, intense irritation of the nerve can occur. “Sciatica “or feelings of pain, aching, numbness, “coldness ‘, paraesthesia or pins and needles of the thigh and calf may occur. This can involve one or both legs. Properly performed manual treatment using massage, mobilisation and manipulation may often be helpful in reducing the severity of low back pain.

Most cases recover without the need for surgery. As mentioned earlier, 90 % patients recover within 6 weeks. However a small group of patients have a significant portion of the nucleus that has herniated out of the annulus of the disc to compress the nerve and removal of the herniated fragment of disc will result in more rapid recovery of symptoms than without.

Frequently Asked Questions

Aside from a prolapsed disc, what other causes of recurrent back and leg pains are there?

Spinal canal stenosis and spondylolisthesis are 2 other common causes of recurrent back and leg pains . In older people, a condition termed as lumbar spondylosis, ( the facet joints of the spine can wear out ) can result in episodic back pains. Osteoporosis or softening of the bones can occur in the elderly, resulting in back pains. Patients who have had a previous history of cancer elsewhere, and having persistent back pains, should seek a medical opinion. Less commonly conditions such as rheumatoid arthritis, ankylosing spondylosis and various types of infections can also afflict the spine.

My back is often sore at the end of a day’s work. How can I prevent this?

Modification of activity or the work environment may be required. It is often how the person does that results in unnecessary stress to the back. Such instruction can be provided by the doctor or the therapist , either as an individual or in groups of patients attending “Back Care ” classes.

I am already doing a full day’s work. I also jog and play tennis Why do I need other exercises?

Work, no matter how strenous, is not exercise. In fact, some jobs especially those that involve repeated lifting or bending, or prolonged standing or sitting, add to the stress over the spine. Jogging, racquet games, golf, etc. may be good for general health and fitness but do not significantly exercise or strengthen the back. A balanced programme which includes improving the flexibility and strength of the back will help to prevent recurrent injuries.

Ankylosing spondylitis is a type of arthritis that affects the spine. Ankylosing spondylitis symptoms include pain and stiffness from the neck down to the lower back. The spine’s bones (vertebrae) may grow or fuse together, resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.

Who Is Affected by Ankylosing Spondylitis?

Ankylosing spondylitis affects about 0.1% to 0.5% of the adult population. Although it can occur at any age, spondylitis most often strikes men in their teens and 20s. It is less common and generally milder in women.

What Are the Symptoms of Ankylosing Spondylitis?

The most common early symptoms of ankylosing spondylitis include:

Pain and stiffness. Constant pain and stiffness in the low back, buttocks, and hips that continue for more than three months. Spondylitis often starts around the sacroiliac joints, where the sacrum (the lowest major part of the spine) joins the ilium bone of the pelvis in the lower back region.

Bony fusion. Ankylosing spondylitis can cause an overgrowth of the bones, which may lead to abnormal joining of bones, called “bony fusion.” Fusion affecting bones of the neck, back, or hips may impair a person’s ability to perform routine activities. Fusion of the ribs to the spine or breastbone may limit a person’s ability to expand his or her chest when taking a deep breath.

Pain in ligaments and tendons. Spondylitis also may affect some of the ligaments and tendons that attach to bones. Tendonitis (inflammation of the tendon) may cause pain and stiffness in the area behind or beneath the heel, such as the Achilles tendon at the back of the ankle.

Ankylosing spondylitis is a systemic disease, which means symptoms may not be limited to the joints. People with the condition also may have fever, fatigue, and loss of appetite. Eye inflammation (redness and pain) occurs in some people with spondylitis. In rare cases, lung and heart problems also may develop.

What Causes Ankylosing Spondylitis?

Although the cause of ankylosing spondylitis is unknown, there is a strong genetic or family link. Most, but not all, people with spondylitis carry a gene called HLA-B27. Although people carrying this gene are more likely to develop spondylitis, it is also found in up to 10% of people who have no signs of the condition.

How Is Ankylosing Spondylitis Diagnosed?

The diagnosis of ankylosing spondylitis is based on several factors, including:

Symptoms

Findings of an physical exam

X-rays of the back and pelvis

Measurements of the chest when breathing

Results of lab tests

How Is Ankylosing Spondylitis Treated?

There is no cure for ankylosing spondylitis, but there are treatments that can reduce discomfort and improve function. The goals of treatment are to reduce pain and stiffness, maintain a good posture, prevent deformity, and preserve the ability to perform normal activities. When properly treated, people with ankylosing spondylitis may lead fairly normal lives. Under ideal circumstances, a team approach to treat spondylitis is recommended. Members of the treatment team typically include the patient, doctor, physical therapist, and occupational therapist. In patients with severe deformities, osteotomy and fusion can be done.

Physical and occupational therapy.Early intervention with physical and occupational therapy is important to maintain function and minimize deformity.

Exercise.A program of daily exercise helps reduce stiffness, strengthen the muscles around the joints and prevent or minimize the risk of disability. Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for people with ankylosing spondylitis.

Medications. Certain drugs help provide relief from pain and stiffness, and allow patients to perform their exercises with minimal discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs)– such as ibuprofen, naproxen, and aspirin — are the most commonly used drugs for spondylitis treatment. In moderate to severe cases, other drugs may be added to the treatment regimen. Disease-modifying anitrheumatic drugs, can be used when NSAIDs alone are not enough to reduce the inflammation, stiffness, and pain.

Surgery. Artificial joint replacement surgery may be a treatment option for some people with advanced joint disease affecting the hips or knees.

Have professional opinion on your Back Pain, Call +65 6471 2744 or Email to info@boneclinic.com.sg

Back Pain

Back pain usually affects the lower back. It can be a short-term problem, lasting a few days or weeks, or continue for many months or even years. Most people will have some form of back pain at some stage in their lives.

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.

Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin or paracetamol, or anti-inflammatory medicine is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

take regular exercise – walking and swimming are particularly beneficial

Back pain is extremely common – about four in five people are affected at some point in their lifetime. Anyone can get back pain at any age, but it’s most common in people between the ages of 35 and 55, or over.

Your back has many interconnecting structures, including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.

It’s often very difficult to know exactly what causes back pain, but it’s usually thought to be related to a strain in one of the interconnecting structures in your back, rather than a nerve problem. Back pain caused by a more serious, underlying condition is rare and you’re unlikely to be affected unless you are very old or very young.

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain and usually improves on its own within a few days.

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

acute back pain – lasting less than six weeks

sub-acute back pain – lasting six weeks to three months

chronic back pain – lasting longer than three months

You should see a doctor as soon as possible if, as well as back pain, you have:

a fever (high temperature)

redness or swelling on your back

pain down your legs and below your knees

numbness or weakness in one or both legs or around your buttocks

loss of bladder or bowel control (incontinence)

constant pain, particularly at night

pain that is getting much worse and is spreading up your spine

These symptoms are known as red flags. It’s important to seek medical help for these symptoms to ensure you don’t have a more serious, underlying cause for your back pain.

For most people with back pain, there isn’t any specific, underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:

standing, sitting or bending down for long periods

lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way

having a trip or a fall

being stressed or anxious

being overweight

having poor posture

There may be other, more serious underlying causes of your low back pain, but these are rare. They include:

fracture – a crack or break in one of the bones in your back

osteoporosis – a condition where bones lose density causing them to become weak, brittle and more likely to break

a slipped disc – this is when a disc bulges so far out that it puts pressure on your spinal nerves

spinal stenosis – a condition in which the spaces in your spine narrow

spondylolithesis – when one of your back bones slips forward and out of position

degenerative disc disease – when the discs in your spinal cord gradually become worn down

osteoarthritis – a wear-and-tear disease that can particularly affect the joints of your spine

rheumatoid arthritis – an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures

Low back pain may also be caused by an infection or cancer, but these two causes are very rare.

Diagnosis of back pain

A doctor will usually be able to diagnose low back pain from your symptoms and there will be no need for further tests. If, however, your symptoms don’t improve after a few weeks, or you have some red flag symptoms, he or she may refer you to have:

an X-ray

a CT scan (a test that uses X-ray equipment and computer software to create pictures of the inside of your body)

an MRI scan (a test that uses magnets and radiowaves to produce images of the inside of the body)

blood tests

These tests are used to find out if you have a more specific, underlying cause for your back pain.

Please note that availability and use of specific tests may vary from country to country.

Treatment of back pain

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.

Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin (acetylsalicylic acid) or paracetamol (acetaminophen), or anti-inflammatory medicine such as ibuprofen is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

take regular exercise – walking and swimming are particularly beneficial